Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Environmental Degradation, Livelihood and Conflicts: A Focus on the Implications of the Diminishing Water Resources of Lake Chad for North-Eastern Nigeria

Lake Chad has been a source of economic livelihood for millions of people inhabiting the catchment areas in the four riparian states, namely: Cameroon, Chad, Niger and Nigeria. However, in the last four decades, the size of the lake including its resources has continued to diminish. The impact of this depletion is being felt by Lake Chad basin population who depend on the lake for their means of livelihood. This paper focuses on the diminishing natural resources of Lake Chad as an empirical referent to analyse the relationship that can develop among natural resource diminution, livelihood and conflicts. Of particular attention is the incidence of conflict between and among fishermen, pastoralists, farmers and sometimes state security agents, and the tendency of the conflicts to degenerate into large scale intra-ethnic, intra-state and interstate conflicts. The paper further draws attention to the implications of the diminishing water resources of the lake for the North-East zone of Nigeria, and makes recommendations suggested by the analysis. African Journal on Conflict Resolution Vol. 8 (2) 2008: pp. 35-6

US Africa Command (AFRICOM) and Nigeria's National Security

The US decision to establish a unified combatant command (AFRICOM) in African has raised numerous questions, particularly in Africa, regarding its possible security implications for the continent. The article narrows itself to the concern for unraveling the national security implications of Nigeria's opposition to the location of AFRICOM. It also highlights the tripartite security concerns that informed US decision to establish a combatant command in Africa. The article argues that Nigeria's opposition to AFRICOM would likely lead to fracturing of US-Nigeria's relations as well as increased, though subtle, intervention of the US in Nigeria's internal affairs. For a win-win approach to the varying legitimate security concerns of Nigeria and the US visà- vis AFRICOM, the article advocates that Nigeria's approach should be underpinned by the philosophy of enlightened moderation and constructive engagement. Africa Insight Vol. 38 (1) 2008: pp. 173-18

Vandals or Victims? Poverty, Risk Perception and Vulnerability of Women to oil Pipeline Disasters in Nigeria

Since the Jesse oil pipeline fire disaster in October 1998 in Delta State, oil pipeline fire disasters have become a recurrent source of morbidity and mortality in Nigeria. Undoubtedly, the past decade has witnessed increasing incidences of pipeline vandalization with concomitant cascading explosions that pose serious threats to human security in Nigeria. One social category that is hardest hit by oil pipeline disasters in Nigeria are women. This paper examines both the sources of risks of oil pipeline disasters and the factors that underlie risk perception by, and the vulnerability of, women to pipeline disasters. It argues that the vulnerability of women to oil pipeline disasters in Nigeria is mediated through complex processes involving geographical, economic, social, and political factors that exposes them to risks as well as greatly influence their perception and interpretation of risk situations. The article concludes with a range of policy recommendations suggested by the analysis.Gender & Behaviour Vol. 6 (2) 2008: pp. 1897-192

From Ahlulsunna wal’jama’ah hijra to Jama’atu Ahlissunnah lidda’awati wal Jihad: The Evolutionary Phases of the Boko Haram Sect in Nigeria

This article examines the evolutionary phases of Nigeria&#8217;s Boko Haram sect, with particular attention to recent suicide bombings. Four broad phases are identified and discussed, along with four factors underlying the inclusion of suicide terrorism in its violent campaign, namely the significant depletion of its fighting force due to heavy losses incurred during the July 2009 revolt; government&#8217;s increased counterinsurgency measures to curtail its traditional tactics of open-armed confrontation or placement of improvised explosive devices; access to more funding; and more importantly, its bonding with foreign terror groups, leading to increased fanatic indoctrination. The article discusses the context of its radicalisation into a violent extremist movement and concludes with recommendations on how to combat the threat posed by the sect, with emphasis on countering suicide terrorism

Corruption and Economic Development in Nigeria: Connections and Evidence from the Power Sector (1999- 2007)

The concern for achieving and sustaining high level of economic development is usually a top priority issue for governments all over the world. Hence, when economic development is planned and financed, what usually determines the success rate is the extent to which the resources earmarked for projects are judiciously and accountably used to meet predetermined goals. Focusing on the power sector between 1999 and 2007, this paper highlights the linkages between corruption and economic development in Nigeria. It argues that corruption in the power sector has significantly hindered economic development in Nigeria. It has contributed to de-industrialization, compounded poverty and unemployment, and undermined human security, among others. Thus, for corruption to be drastically reduced in Nigeria, the paper recommends the introduction and strengthening of more preventive, punitive and inter-agency cooperative measures

Gender and Human Security: Reflections on the

This paper examines the relationship between gender, human security and HIV/AIDS epidemic in Nigeria. It explores this by critically examining the factors that promote the susceptibility and vulnerability of women/girls to contracting HIV/AIDS infection in Nigeria. It argues that in a patriarchal society such as Nigeria, gender is the prop on which vulnerability to HIV/AIDS and threats to human security rest. It further examines how cultural, political, socio-economic, and governance variables interplay to create and exacerbate the vulnerability of women/girls to contracting HIV/AIDS. Although the prevalence of the disease has declined since 2003, the paper observed that HIV/AIDS in Nigeria has disproportionately affected women. To better respond to the scourge of HIV/AIDS in Nigeria, the paper calls for the refocusing of campaign efforts on the rural areas; appropriate funding of the health sector; empowerment of women through proactive legislations; and greater representation of women in governance institutions to ensure that the formulation of public policies as well as the management of public resources is attuned towards greater responsiveness to the peculiar needs and challenges of women.

Gender and Human Security: Reflection on the Vulnerability of women to HIVAIDS in Nigeria

This paper examines the relationship between gender, human security and HIV/AIDS epidemic in Nigeria. It explores this by critically examining the factors that promote the susceptibility and vulnerability of women/girls to contracting HIV/AIDS infection in Nigeria. It argues that in a patriarchal society such as Nigeria, gender is the prop on which vulnerability to HIV/AIDS and threats to human security rest. It further examines how cultural, political, socio-economic, and governance variables interplay to create and exacerbate the vulnerability of women/girls to contracting HIV/AIDS. Although the prevalence of the disease has declined since 2003, the paper observed that HIV/AIDS in Nigeria has disproportionately affected women. To better respond to the scourge of HIV/AIDS in Nigeria, the paper calls for the refocusing of campaign efforts on the rural areas; appropriate funding of the health sector; empowerment of women through proactive legislations; and greater representation of women in governance institutions to ensure that the formulation of public policies as well as the management of public resources is attuned towards greater responsiveness to the peculiar needs and challenges of women.Gender and Human Security: Reflections on the Vulnerability of Women to HIV/AIDS Scourge in Nigeria